| Jlc Services Inc. | |
|
3201 E Royalton Rd Broadview Heights OH 44147-2858 | |
| (330) 687-0742 | |
| Not Available |
| Full Name | Jlc Services Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3201 E Royalton Rd, Broadview Heights, Ohio |
| Authorized Official Name and Position | Alyssa Love (CLINICAL OVERSIGHT MANAGER) |
| Authorized Official Contact | 7404051036 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jlc Services Inc. 3201 E Royalton Rd Ste 30 Broadview Heights OH 44147-2858 | Jlc Services Inc. 3201 E Royalton Rd Broadview Heights OH 44147-2858 Ph: (330) 687-0742 |
| NPI Number | 1417739699 |
|---|---|
| Provider Enumeration Date | 10/20/2023 |
| Last Update Date | 02/18/2025 |
| Certification Date | 02/18/2025 |
| Medicare PECOS PAC ID | 3870931322 |
|---|---|
| Medicare Enrollment ID | O20250106000247 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417739699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | () | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | () | Primary |
| Provider Name | Katie Pruitt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215641071 PECOS PAC ID: 9234504317 Enrollment ID: I20230403000551 |
| Provider Name | David Lopez |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1275629719 PECOS PAC ID: 0648241232 Enrollment ID: I20250107000496 |
| Provider Name | Sondra Cobbler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396567517 PECOS PAC ID: 0941722904 Enrollment ID: I20250319001605 |
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